Health Insurance
Some services in your health cover may be grouped with others to give you a total amount you can claim on that group of services each calendar year. This is called a “combined limit” or a “combined maximum” and is separate to “lifetime limits”.
For example, your cover might provide a combined yearly limit of $600, per person, for dental. This means each person on your cover can claim up to $600 across one, or the whole range, of dental services listed. Once you’ve reached the limit, you won’t be able to claim on any of the individual services in that group until your limits re-set on 1 January the following year.
There may also be a “sub-limit” for a service—or services—within these groups. This is the maximum amount you can claim for that individual service within the combined limit each year. For example, you may have a $600 combined limit to claim on dental but, within that, a sub-limit of $300 for crowns, bridges and dentures.
If you’re on a family policy, there may be per person sub-limits as well as family sub-limits.
A “waiting period” is the time you’ll need to wait before you become eligible to benefits for a particular service, or services, on your health cover.
A waiting period usually applies when you:
Once you’ve served your waiting period, you’ll be able to start claiming—but only on services or treatments that occurred after you served it.
Different waiting periods may apply to each of your benefits. Check your Fact Sheet to find out what applies to you.
Switching to Australian Unity?
You may not need to re-serve waiting periods if you’ve served them with another provider and are:
A gap in cover of more than 30 days means you will have to re-serve all waiting periods.
Upgrading your existing Australian Unity cover?
If you’re upgrading your cover, you may need to serve the relevant waiting periods before receiving higher benefits for a particular service. You’ll still receive the benefits of your previous level of cover while you’re doing this.